1. Field of Invention
This invention relates to a composition for treating a skin disorder in a human, and a method of administering and preparing such composition.
2. Background
Skin disorders are a common problem in childhood, adolescence and adulthood. Skin disorders can include, for example, acne, inflammatory diseases such as atopic eczema, or rosacea.
Acne vulgaris is a follicular disease characterized by pilosebaceous inflammations such as comedones, papules, pustules, cysts and nodules. Chiefly a disease of adolescence (and often a cause of emotional distress), acne originates endogenously and stems for multifactorial influences. Major progressive factors in the development acne include hyperkeratosis of the follicular epithelium, increased sebum production, and proliferation of Propionibacterium acnes. These factors are primarily responsible for hyperkeratosis of the follicle lining, including retention of keratin and sebum, as well as the free fatty acid by-products of P. acnes metabolization which can lead to inflamed acne papules and pustules.
Although acne may also be influenced by exogeneous and hormonal factors, research has been centered around eliminating P.acnes, the most common cause of inflammation. To date, the pathogenesis of acne is not fully understood, and there is currently no cure for the disease. Many systemic and topical medications, such as tetracycline, have been used to manage and control acne. None, however, is universally successful.
Acne treatment is typified by xe2x80x9cpolypharmacyxe2x80x9d, whereby physicians employee simultaneous treatment with a variety of modalities. The search for improved acne treatments has been widespread and continuous during the past several decades. Enhanced cosmetic properties to encourage user compliance, the use of topical therapies in place of systemic drugs to reduce toxicity and side effects, and the introduction of new drugs and formulations represent the forefront of acne treatment advances.
The first use of a topical antibiotic, erythromycin, for the treatment of acne was reported by Fulton (Fulton, J. E. Jr. and Pablo, G. Topical antibacterial therapy for acne. Study of the family of erythomycins. Arch. Dermatol. 110:83-86, 1974). Topical administration of these potent agents has the advantage of reduced side effects, particularly those caused by systemic drug effects, e.g., nausea, gastrointestinal upset, diarrhea, and vaginal yeast overgrowth.
Lincomycin antibiotics have been employed in the topical treatment of acne (U.S. Pat. No. 3,969,516). Lincomycin was commercialized by Upjohn Co. (now Pharmacia and Upjohn) as Cleocin T Solution, Gel, Lotion and Pledgets. Cleocin T Gel was an improvement over Cleocin T Solution because of the elimination of alcohol and the ease of application to the facial skin for the treatment of acne. This gel is based on carbomer 934, NF.
Atopic dermatitis is a polygenic disease with an inherited predelection and strongly influenced by environmental factors. The condition affects infants, children, adolescents and adults and is allergic in nature. The distribution is symmetrical, typically involving the face, neck and flexural areas. Atopic dermatitis is chronic, relapsing and usually pruritic. Topical treatment frequently includes topical corticosteroids, such as desonide, hydrocortisone valerate, fluocinolone acetonide, triamcinolone acetonide, betamethasone valerate, hydrocortisone butyrate, halobetasol propionate, betamethasone dipropionate, clobetasol propionate, difloransone diacetate, fluticasone propionate, budesonide or the like.
Rosacea is a chronic inflammatory eruption of the nose, face and other flushing areas of the skin. The disease is most common in middle aged women and is characterized by erythema, papules, pustules, telangiectasia and enlarged sebaceous glands. The cause etiology is not totally clear; however vasomotor lability and menopause are predisposing factors. The organism Demodex folliculorum is found frequently in the contents of inflamed pustular follicles, and has a possible role in this skin disorder. Treatments include topical metronidazole and oral tetracycline type antibiotics.
One aspect of this invention is a composition having a pH of about 3.0 to about 9.0 and a viscosity of less than about 15,000 centipoise (cP) for treating a skin disorder in a human subject. The composition comprises (a) a therapeutically-effective amount of at least one compound useful for treating such disorder, (b) a pharmaceutically-acceptable polyacrylic acid polymer compatible with the compound, (c) optionally a water miscible solvent, (d) optionally a preservative, (e) optionally an oil phase and surfactant, and (f) water.
Another aspect of the invention is a composition described above in combination with a container that accurately administers a portion of the composition for topical administration to a patient.
Another aspect of the invention is a composition described above in combination with labeling instructions for use in treating the skin disorder.
Still another aspect of the invention is a method for treating a skin disorder in a human subject, which method comprises administering a composition described above to an affected area of the subject""s skin having such disorder in an amount and for a period of time sufficient to improve the skin disorder.
Still another aspect of the invention is a method for preparing a composition of this invention by combining water with a therapeutically-effective amount of a suitable compound and the polymer and optionally a water-miscible solvent and preservative. If a lotion is desired an oil phase is formed for integration with the aqueous phase.
Other aspects of the invention may be apparent upon further reading the specification and claims of the patent application.
This invention provides a novel topical gel or lotion delivery system for the treatment of skin diseases, particularly acne vulgaris. One unique aspect of the system is the use of a polymeric material that provides a gel material that has a very low viscosity but which is cosmetically elegant and aids in the administration process by providing a pourable composition that flows through a dropper tip easily.
One aspect of this invention is a composition having a pH of about 3 to about 9 and a viscosity of less than about 15,000 cP for treating a skin disorder in a human subject. The composition comprises a therapeutically-effective amount of at least one compound useful for treating such disorder, a pharmaceutically-acceptable, lightly cross-linked polyacrylic acid polymer compatible with the therapeutically-effective compound, optionally a water miscible solvent, optionally a preservative, and water. The composition may include a solution of the active compound or a suspension. A lotion will also include a pharmaceutically-acceptable oil phase emulsified with one or more surfactants.
The composition is useful to treat skin disorders, e.g. acne, rosacea, or inflammatory skin diseases such as atopic dermatitis. The composition will include an active agent that will be one compound alone or two or more compounds in combination. The active agent can be an antibiotic, a corticosteroid, a retinoid, an anti-inflammatory imidazole, a non-steroidal anti-inflammatory agent (NSAID), or a combination.
An antibiotic is generally viewed as a drug that inhibits the growth of an unwanted microorganism. Representative examples of topical antibiotics include lincomycins, (e.g. clindamycin), erythromycin, minocycline, and tetracycline, and the pharmaceutically-acceptable salts, esters, or prodrugs thereof. Preferred is clindamycin phosphate.
A xe2x80x9cretinoidxe2x80x9d is a keratolytic drug related to retinoic acid and generally includes chemical entities such as retinol and its esters and closely related naturally-occurring derivatives and structurally-related synthetic analogs. This includes, for example, retinol, retinal, tretinoin (all-trans retinoic acid), isotretinoin, adapalene (6-[3-(1-adamantyl)-4-methoxyphenyl]-2-naphthoic acid), and the like. Of these, tretinoin is preferred.
Generally, a topical corticosteroid is a compound that is a structural modification of hydrocortisone (also known as cortisol) and that shows topical anti-inflammatory activity. Representative examples include those set forth in Table 65-1 at page 1575 of xe2x80x9cGoodman and Gilman""s The Pharmacological Basis of Therapeutics,xe2x80x9d Eighth Edition, McGraw-Hill, Inc. (1993). Specific, non-limiting examples of topical cortiocosteroids include those mentioned in the xe2x80x9cbackgroundxe2x80x9d section of this application. Preferred corticosteroids, when used as a single active agent, include diflorasone diactetate, fluticasone propionate, halobetasol priopionate, or budesonide. Halobetasol propionate is most preferred when used as a single active ingredient.
Nonsteroidal anti-inflammatory agents (NSAIDs) are compounds that suppress the inflammatory response when topically applied by inhibiting prostaglandin synthesis or by other mechanisms of action. Examples may be found in Goodman and Gilman, Ibid. Representative examples include ibuprofen, indomethacin, diclofenac, and naproxen and their salts. Preferred is diclofenac.
An anti-inflammatory imidazole is an imidazole compound that suppresses a topical inflammatory response. Metronidazole is a representative imidazole compound suitable for this invention.
In describing the details of the composition, the numerical ranges given herein are those amounts that provide the functional results in the composition. Thus, the ranges are generally introduced with the term xe2x80x9caboutxe2x80x9d to indicate a certain flexibility in the range, i.e. xc2x110% or less at the lower and upper numerical ranges given.
As mentioned, the active agent may be present alone or in combination. For example, a topical antibiotic, such as clindamycin phosphate, may be combined with a topical corticosteroid. Where a formulation is designed primarily for application to the facial area, to treat acne for example, it is preferred to combine an antibiotic (e.g. clindamycin phosphate) with a less potent corticosteroid, such as desonide, hydrocortisone valerate, fluocinolone acetonide, hydrocortisone butyrate, or triamcinolone acetonide. The topical antibiotic can also be combined with a retinoid, e.g clindamycin phosphate and tretinoin or adapalene.
The composition of the invention will include a polymeric material that will be present in an amount sufficient to bring the viscosity of the composition to a level of not more than about 15,000 cP, preferably between about 100 and about 12,000, and more preferably between about 300 and about 10,000. The viscosity is determined at room temperature (20-25xc2x0 C.) using a Brookfield viscometer model DV-I+, spindle #27 at 12 revolutions per minute (rpm). If the measured viscosity is less than 4,000 cP, spindle #21 should be used instead of #27. By keeping the viscosity below about 15,000 cP, the advantages of more appealing cosmetic characteristics and ease of accurate application through improved flow and pourability are achieved.
The polymers that have been found to be particularly useful in the composition of the present invention are lightly cross-linked polyacrylic acid polymers which are available from B.F. Goodrich under the tradename CARBOPOL(copyright). They are generically referred to as carbomers. The CARBOPOL polymers are hydrophilic polymers based on a polyacrylic acid structure. For use in the present invention the lightly cross-linked polymers include CARBOPOL 910, 941,971, and 981 and CARBOPOL ETD 2050.
Either CARBOPOL 941 or 981 is particularly valuable for the present invention because the viscosity of a gel based on CARBOPOL 941 or 981 is low relative to its concentration. This feature is the result of the low level of cross-linking within the polymer structure in a neutralized aqueous system. In contrast polyacrylic acid polymers which display a high level of cross-linking, such as CARBOPOL 980 or 974P, produce gels with higher viscosity at comparable concentrations.
A 0.5% solution of either CARBOPOL 941 or 981 at pH 7.5 has a viscosity measurement of from 4,000 to 11,000 cP (Brookfield viscometer at 20 rpm) compared to a viscosity measurement of from 40,000 to 60,000 cP for a comparable 0.5% solution of either CARBOPOL 940 or 980 (reference: B.F. Goodrich Product Guide, Bulletin 2).
This lower-level viscosity feature of the lightly cross-linked polyacrylic acid polymers, e.g. CARBOPOL 941 and 981, offers two advantages to the composition of the present invention. A gel made from one of these lightly cross-linked polymers provides better skin feel and lubricity than a gel of comparable viscosity made from a highly cross-linked polymer. Second, a low viscosity gel can be administered very accurately by a dropper or drip-type dispenser as compared to other commercial products which are thicker gels that do not provide as accurate an application.
CARBOPOL 941 NF resin and its cosolvent polymerized alternative, CARBOPOL 981 NF resin, provide permanent emulsions and suspensions at low viscosities. The gels produced with these resins have excellent clarity. In ionic systems, they perform better than most of the other CARBOPOL resins and at concentrations below 1.5% in solvent systems. The polymers are available from B.F. Goodrich Specialty Chemicals, 9911 Brecksville Road, Cleveland, Ohio 44414-3247.
CARBOPOL resins are polymers of acrylic acid crosslinked with polyalkenyl ethers or divinyl glycol. The polymers are flocculated powders of primary particles averaging about 0.2 micron in diameter. The flocculated powders are agglomerates that average 2 to 7 microns as determined by Coulter Counter. These agglomerates cannot be broken down into the primary particle once produced.
Each primary particle can be viewed as a network structure of polymer chains interconnected by crosslinks. Without the crosslinks, the primary particle would be a collection of linear polymer chains intertwined but not chemically bonded. These linear polymers are soluble in a polar solvent, such as water. They swell in water up to 1000 times their original volume (and ten times their original diameter) to form a gel, especially when exposed to a pH environment above about 4-6. Since the pKa of these polymers is 6.0xc2x10.5, the carboxylate groups on the polymer backbone ionize, resulting in repulsion between the negative particles, which adds to the swelling of the polymer. Highly crosslinked polymers of this type do not dissolve in water, rather they form gels by forming homogeneous dispersions.
The glass transition temperature of CARBOPOL resin is 105xc2x0 C. (221xc2x0 F.) in powder form. However, the glass transition temperature drops dramatically as the resin comes into contact with water. The polymer chains start gyrating and the radius of gyration becomes bigger and bigger. Macroscopically, this phenomenon manifests itself as swelling.
The aqueous composition of the invention, will optionally include a water miscible solvent and a preservative. The water miscible solvent (i.e. a cosolvent) will be present if needed, to assist in dissolving the active agent. The cosolvent may be a single component or a mixture. Examples include those that are miscible with water such as ethanol, propylene glycol, glycerin, polyethylene glycol 400, and the like. Certain water-miscible solvents, such as glycerin or propylene glycol, also add beneficial humectant properties to the composition. Drug delivery and penetration into the skin can be modified by the water-miscible cosolvent composition.
The preservative useful in the composition is material that aids in ensuring a stable composition and/or prevents growth of bacteria. Thus, a preservative may be one or more of an antioxidant, a chelator, an antibacterial, or the like. Suitable preservatives include methylparaben, butylparaben, propylparaben, benzyl alcohol, sorbic acid, imidurea, thimerisal, propyl gallate, BHA, BHT, citric acid, disodium edetate, and the like. Another optional additive is a fragrance. Generally, this will be present in a trace amount only and has no effect on the functioning of the composition.
A preferred composition, particularly for the treatment of acne, will exhibit a pH of about 3 to 9, preferably about 4 to 7, and most preferably at about 5 to 6. Thus, the composition may also include a pH-adjusting agent as needed at a level to adjust the pH to the desired range. Such agents include many pharmaceutically-acceptable organic or inorganic bases, e.g., sodium hydroxide and tromethamine. The pH chosen will depend in part on the pH tolerance of the active agent chosen for the composition. The examples provide guidance for certain compounds and suitable pH values for the compositions.
Another aspect of this invention is an emollient embodiment, i.e., a fluid emulsion or lotion. This aspect of this invention is a composition having an internal oil phase dispersed with the aid of at least one surfactant, e.g. an emulsifier, in water. Suitable surfactants are well known in the art and include those referred to as anionic and nonionic agents. These are described in Remington: The Science and Practice of Pharmacy, Nineteenth Edition, Vol. 1 at p. 251. Representative surfactants include polysorbate 20, polysorbate 40, polysorbate 60, polysorbate 80, sorbitan laurate, sorbitan oleate, sorbitan stearate, polyoxyethylene stearate, sodium laureth sulfate, and laureth-10. Oil phase components include those that are commonly used in the art such as mineral oil, petrolatum, stearyl alcohol, cetyl alcohol, isopropyl myristate, diisopropyl adipate, stearic acid, white wax, and the like.
The following Table sets forth operational and preferred ranges of the various components for a gel composition having an active ingredient, which may be a single compound or a combination of two or more compounds. The term surfactant means one or more surfactants, which includes wetting agents and emulsifiers.
The following Table B sets forth the operational, preferred, and more preferred concentrations of representative active ingredients that can beneficially be used in practicing our invention, whether alone or in combination. The exact amount will be readily determined by one of ordinary skill by referencing standard texts such as the Physicians Desk Reference or Goodman and Gilmann""s referred to hereinbefore.
To make an emulsion (i.e., lotion) form of our invention as broadly set forth in Table A, the surfactant and oil phase component are included in the composition. The following table illustrates the manner in which the composition is modified to form a lotion.
The preferred formula of the composition would either be preservative-free or have a decreased level of preservatives as compared to material that is commercially available. This is important because the presence of preservatives in a composition can result in irritation or allergic reaction of the skin. Reducing the possibility of skin irritation or allergic reaction in a composition provides a better product. Regarding compositions that contain clindamycin phosphate, the leading product is Cleocin T Gel. It is a clear viscous gel that tests have shown is not as well accepted as the less viscous material of the invention made with a more lightly cross-linked polymer. By controlling the viscosity of the gel at a low level it can be accurately dispensed from a clear plastic squeeze bottle rather than from an ointment tube. The advantage is two-fold. One is accurate dosage control by using a reduced orifice tip and improved product presentation for marketing. In addition, tests have shown that the less viscous material is cosmetically more elegant and will result more regular use.
In preparing a composition of this invention general formulation techniques known in the art of pharmaceutical science will be used. See, for example, Remington: The Science and Practice of Pharmacy, Nineteenth Edition, Mack Publishing Company (1995). Preparation of specific formulations may be found in the examples.
To prepare a gel with two active ingredients where one is suspended and the other is dissolved, first add the insoluble active to a water-miscible ingredient, or a portion of the water with a surfactant, to disperse. Separately, dissolve the other active and any other preservative ingredients in the purified water. Disperse the gelling agent in the aqueous solution with appropriate stirring. Then add the dispersion of the first active ingredient to the gel and mix well to blend. Last, add a pH adjusting agent to adjust the pH to the desired range. The preparation of a gel when both active ingredients are dissolved is similar, varying only in the first step. First, add the active with lower aqueous solubility to a solvent, blend of solvents, or water. Mix to dissolve. Separately, dissolve the other active and any preservative ingredients in the purified water. Disperse the gelling agent in the aqueous solution with appropriate stirring. Then add the solution of the first active to the gel and mix well to blend. Last, add a neutralizing agent to adjust the pH to the desired range.
For a combination of an antibiotic e.g. clindamycin phosphate with a retinoid, such as tretinoin, three formulation approaches can be applied to a composition of the invention: 1) an aqueous gel, formed from a lightly crosslinked carbomer gelling agent, with the clindamycin phosphate dissolved and the tretinoin suspended; 2) an oil-in-water emulsion with the clindamycin phosphate dissolved in the water thickened with a lightly cross-linked carbomer gelling agent and the tretinoin dissolved in an internal liquid oil phase; and 3) a solution consisting of water and water-miscible organic solvents with the clindamycin phosphate and tretinoin both dissolved.
The following compositions are given as representative as the types of compositions useful in this invention.
Where the composition contains an antibiotic alone, for example clindamycin phosphate, the composition has a pH of about 4 to 7 and contains
(a) about 0.5% to 2.0% w/w clindamycin phosphate,
(b) about 0.1% to 0.4% w/w of the polymer,
(c) the base to adjust pH,
(d) about 15.0% to 25.0% w/w of a water miscible solvent,
(e) less than about 0.2% w/w of a preservative, and
(g) QSAD purified water to 100% w/w.
Preferably such a composition has a pH of about 5 to 6 and contains
(a) 1.0 to 1.5% w/w clindamycin phosphate,
(b) 0.2% w/w of the polymer,
(c) the base to adjust pH,
(d) 15.0% w/w propylene glycol and 5.0% w/w polyethylene glycol 400,
(e) 0.1-0.15% w/w methylparaben, and
(g) QSAD purified water to 100% w/w.
A gel composition where the antibiotic in clindamycin phosphate and the retinoid is tretinoin may contain
(a) (i) about 0.5% to about 2.0% w/w clindamycin phosphate, and
(ii) about 0.01% to about 0.05% w/w tretinoin;
(b) about 0.1% to about 0.5% w/w of the polymer;
(c) the base to adjust pH;
(d) about 10% to about 30% w/w of a water-miscible solvent;
(e) less than about 0.2% of a preservative; and
(g) QSAD purified water 100% w/w.
A lotion composition of clindamycin phosphate and tretinoin usefully will contain
(a) (i) about 0.5% to about 2.0% w/w clindamycin phosphate and
(ii) about 0.01% to about 0.05% w/w tretinoin;
(b) about 0.1% to about 0.5% w/w0 of the polymer;
(c) the base to adjust pH;
(d) about 5% to about 30% w/w of a water-miscible solvent;
(e) less than about 0.2% of a preservative;
(f) an oil phase in combination with at least one surfactant to form an emulsion; and
(g) QSAD purified water 100% w/w.
Another aspect of the invention is a method for treating a skin disorder in a human, which method comprises administering a composition to an affected area of the subject""s skin having such disorder in an amount and for a period of time sufficient to improve the skin disorder, wherein the composition is described in this patent application. Preferably, the composition is administered once a day over the treatment period. Depending on the patient""s improvement, the treatment may extend for less than a week to two months or more. The progress of improvement may be monitored by the patient or by a physician.
The skin disorders which are treatable with the composition of the invention include acne vulgaris, rosacea, and various inflammatory conditions including atopic dermatitis. A discussion of these conditions may be found in the Merck Manual. For example, acne vulgaris is an inflammatory disease affecting hair follicles and sebaceous glands. Lesions are most common on the face, but the neck, chest, upper back, and shoulders may also be affected.
The affected area of the subject""s skin can be anywhere on the body in which the skin disorder exists. The amount of composition and period of administration time sufficient to improve the skin disorder will be dependent on the subject and skin condition. Generally, a sufficient amount will be squeezed from a dropper tip of a squeeze bottle or an eye dropper onto the area affected and rubbed gently into the skin. Usually, no more than a few drops will be needed to apply to an affected area.
Another aspect of the invention is an article of manufacture that comprises a composition for treating a skin disorder as described above in a suitable container, preferably in a dropper bottle, in combination with labeling instructions. The dropper bottle can be made of any material, for example, glass, rigid plastic, or flexible plastic. Other means of administration are an eyedropper, or tube with a suitable small orifice size, such as an extended tip tube.
The composition of this invention may be, for example, filled and packaged into a plastic squeeze bottle (i.e., 42 g). A suitable container-closure system for the package presentation for the composition described in Table D.
The labeling instructions can come in the form of a pamphlet, a label applied to or associated with the packaging of the article of manufacture.
The labeling instructions provide for administering a composition of the invention to an affected area of a subject""s skin having a skin disorder, in an amount and for a period of time sufficient to improve the skin disorder. Printed labeling instructions are functionally related to the composition of the invention inasmuch as such labeling instructions describe a method to treat a skin disorder. The labeling instructions are an important aspect of the invention in that before a composition can be approved for any particular use, it must be approved for marketing by the United States Food and Drug Administration. Part of that process includes providing a label that will accompany the pharmaceutical composition which is ultimately sold. While the label will include a definition of the composition and such other items such as the clinical pharmacology, mechanism of action, drug resistance, pharmacokinetics, absorption, bioavailability, contraindications and the like, it will also provide the necessary dosage, administration and usage. Thus, the combination of the composition with the dropper bottle with appropriate treatment instructions is important for the proper usage of the drug once it gets on the market. Such treatment instructions will describe the usage in accordance with the method of treatment set forth herein before.